Can a lipophilic statin improve the treatment of heart failure with preserved ejection fraction in patients with hypertension and obesity?

Aim. To evaluate the effect of pleiotropic (anti-inflammatory and antifibrotic) effects of a lipophilic statin (atorvastatin) in the treatment of heart failure (HF) with preserved left ventricular (LV) ejection fraction (HFpEF)

Material and methods. This observational study included 80 patients with HFpEF; 40 of them received atorvastatin 20-80 mg/day in addition to a standard treatment. 40 patient who refused of the statin treatment or had intolerance of the drug received only the standard treatment. The follow-up period was 12 months and included 5 visits. At the visits, the general condition of patients was evaluated; electrocardiography and echocardiography were performed at rest and during dosed physical exercise (PE); anthropometry was analyzed; and office blood pressure (BP), heart rate (HR) and parameters of systolic and diastolic LV function were recorded.

Results. Among the patients included into the study, women aged 60-70 years prevailed who had pronounced obesity (n=46; 57.5% with class II–II obesity), severe arterial hypertension (AH) (n=65; 81.2% with grade 3 hypertension), dyslipidemia, type 2 diabetes mellitus, and chronic kidney disease. The administration of atorvastatin in addition to standard therapy was associated with regression of HF symptoms and increased PE tolerance; these effects were more pronounced after 6 months of observation. Furthermore, during a 12-month follow-up, significant multidirectional changes in LV global longitudinal strain were noted; in the main group, the LV global longitudinal strain increased indicating an improvement in the LV systolic function while in the control group, it decreased reflecting early, preclinical manifestations of HF progression. A diastolic stress test in combination with a cardiopulmonary stress test was performed in 64 patients with HFpEF at enrollment and at 6 and 12 months of follow-up. When the load reached 50 W in the atorvastatin treatment group after 12 months, a significant increase in tissue Doppler velocity parameters was revealed, specifically in e’ septal and e’ lateral. This led to a significant decrease in the E / e’ ratio while in the control group, no time-related changes in these parameters were noted. Similar changes were also detected at higher levels of PE.

Conclusion. Long-term use of the lipophilic statin (atorvastatin) in addition to a standard therapy was associated with regression of clinical manifestations of HFpEF, provided preservation of the systolic function, and some improvement in the LV diastolic function both at rest and during dosed PE.

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